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Inadequacy of antenatal care attendance and its determinants amongst pregnant women in Ethiopia based on the 2019 Mini-Ethiopian demographic health survey: secondary data analysis. 基于 2019 年小型埃塞俄比亚人口健康调查的埃塞俄比亚孕妇产前保健就诊率不足及其决定因素:二手数据分析。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-18 DOI: 10.1186/s12884-024-06884-3
Asaye Alamneh Gebeyehu, Anteneh Mengist Dessie, Melkamu Aderajew Zemene, Rahel Mulatie Anteneh, Ermias Sisay Chanie, Natnael Kebede, Natnael Moges, Sintayehu Simie Tsega, Melaku Ashagrie Belete, Ermiyas Alemayehu, Denekew Tenaw Anley

Background: Inadequacy of antenatal care (ANC) utilization is a prominent public health problem, causing poor pregnancy outcomes. In developing countries, including Ethiopia, having ANC coverage, many pregnant women do not achieve the first ANC visits in the first trimester and receive at least four ANC visits. Therefore, this study aimed to examine the magnitude and identify determinants of inadequacy of antenatal care attendance amongst pregnant women in Ethiopia.

Methods: Inadequate ANC attendance was defined as combining starting ANC visits after the first trimester and having fewer than four visits together. The study used secondary data from the 2019 mini-demographic and health survey. A weighted sample of 3927 pregnant women was included in this study. Data management and further analysis were performed using STATA 14 software. A multivariable generalized estimating equation analysis was used to identify determinants associated with inadequacy of antenatal care attendance. The Adjusted odds ratio with a 95% confidence interval was used to identify significant variables for inadequate antenatal care visits.

Result: Overall, 78.5% of pregnant women did not attend adequate antenatal care visits during pregnancy. In multivariable generalized estimating equation analysis, women aged 25 to 34 years (AOR = 0.77, 95% CI: 0.61-0.95), being educated (AOR = 0.31; 95% CI: 0.22-0.45), and being wealthier index (AOR = 0.67, 95% CI: 0.51-0.88) were less likely to inadequate antenatal care attendance. Whereas being rural residents (AOR = 1.49; 95% CI:1.08-2.07), no television exposure (AOR = 1.51; 95% CI:1.1-2.06), having more family members in the household (AOR = 1.81; 95% CI: 1.11-2.95), and women from semi-peripheral region (AOR = 1.92; 95% CI: 1.42-2.59) were higher odds of being associated with inadequacy of antenatal care attendance.

Conclusions: The prevalence of Inadequate antenatal care attendance amongst pregnant women in Ethiopia is still High. The study identifies significant variables that could be positively and negatively associated with inadequate antenatal care visits. Health education interventions should target uneducated, poorer, and rural women to attend early antenatal care and use at least four antenatal care utilization for early detection of complications during pregnancy and delivery.

背景:产前保健(ANC)利用率不足是一个突出的公共卫生问题,会导致不良的妊娠结局。在埃塞俄比亚等产前检查覆盖率较高的发展中国家,许多孕妇无法在怀孕前三个月进行首次产前检查,也无法接受至少四次产前检查。因此,本研究旨在探讨埃塞俄比亚孕妇产前保健就诊率不足的严重程度,并确定其决定因素:产前检查就诊率不足的定义是在头三个月后开始接受产前检查,且就诊次数少于四次。研究使用了 2019 年小型人口与健康调查的二手数据。本研究纳入了 3927 名孕妇的加权样本。数据管理和进一步分析使用 STATA 14 软件进行。研究采用了多变量广义估计方程分析,以确定与产前保健就诊不足相关的决定因素。使用调整后的几率和 95% 的置信区间来确定产前检查次数不足的重要变量:结果:总体而言,78.5%的孕妇在怀孕期间没有参加适当的产前检查。在多变量广义估计方程分析中,年龄在 25 至 34 岁(AOR = 0.77,95% CI:0.61-0.95)、受教育程度(AOR = 0.31;95% CI:0.22-0.45)和富裕指数(AOR = 0.67,95% CI:0.51-0.88)的妇女较少出现产前检查次数不足的情况。而农村居民(AOR = 1.49;95% CI:1.08-2.07)、不看电视(AOR = 1.51;95% CI:1.1-2.06)、家中有较多家庭成员(AOR = 1.81;95% CI:1.11-2.95)和来自半边缘地区的妇女(AOR = 1.92;95% CI:1.42-2.59)与产前护理服务不足相关的几率较高:埃塞俄比亚孕妇产前保健服务不足的发生率仍然很高。这项研究发现了可能与产前检查次数不足正相关和负相关的重要变量。健康教育干预措施应以未受过教育、较贫穷和农村妇女为目标,让她们及早参加产前护理,并至少利用四次产前护理,以便及早发现怀孕和分娩期间的并发症。
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引用次数: 0
Pregnancy-Induced Hypertensive Disorders predictors among pregnant and delivery mothers receiving care in public health institutions in Sidama, Ethiopia: a multicenter case control study. 在埃塞俄比亚西达马公共医疗机构接受护理的孕妇和产妇的妊娠高血压疾病预测因素:一项多中心病例对照研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-18 DOI: 10.1186/s12884-024-06886-1
Girma Tenkolu Bune
<p><strong>Background: </strong>Pregnancy-Induced Hypertensive Disorders (PIHD) include conditions like Pre-Eclampsia, Eclampsia, and Gestational Hypertension, impacting 5-10% of pregnancies globally. These disorders are responsible for 16% of maternal deaths in Sub-Saharan Africa and account for 16.9% of maternal mortality in Ethiopia, representing 10% of the country's total maternal deaths.</p><p><strong>Objective: </strong>To identify predictors of PIHD among pregnant and delivery women in public hospitals and primary health care units (health centers) in Sidama, Ethiopia.</p><p><strong>Methods: </strong>A multi-center unmatched case-control study was conducted on women in antenatal care and obstetrics/gynecology departments at 12 randomly selected public health institutions, including one specialized teaching hospital, two general hospitals, three primary hospitals, and six health centers. The study involved 920 women (230 cases and 690 controls) selected from December 2023 to February 2024. Cases included pregnant or delivery women at 20 + weeks gestation with PIHD such as pre-eclampsia, eclampsia, gestational hypertension, and chronic hypertension with superimposed preeclampsia. Controls were normotensive pregnant women or delivering mothers without PIHD after 20 weeks gestation. Data was manually verified, entered, and validated using Epidata software, followed by analysis with SPSS 22. Univariate analysis assessed predictors of PIHD, while binary logistic regression evaluated the relationships between factors. Model fitness was checked using collinearity assessments and the Hosmer-Lemeshow test, with variables having a P value < 0.05 deemed independent predictors.</p><p><strong>Results: </strong>Out of 920 planned participants, 686 were included, resulting in a response rate of 94.35%. Factors associated with PIHD in women included age at first conception (AOR = 1.26), mid (AOR = 6.05) and high (AOR = 5.01) wealth index levels, multigravidity (AOR = 4.34), pregnancy age ≥ 42 weeks (AOR = 3.65), maternal mid-upper arm circumference (MUAC) (AOR = 1.29), hemoglobin levels of 6.5-10.9 g/dL (AOR = 5.59), pre-pregnancy Body Mass Index (BMI) ≥ 25 kg/M<sup>2</sup> (AOR = 0.81), preexisting hypertension (AOR = 8.97), family history of diabetes mellitus (AOR = 20.02), former alcohol consumption (AOR = 0.27), and total physical activity during pregnancy (AOR = 0.54).</p><p><strong>Conclusions: </strong>The study identifies key predictors of PIHD in women, including age at conception, wealth index, multigravidity, gestational age, and pre-pregnancy BMI. It underscores the link between socioeconomic status and maternal health, highlighting that financial resources alone don't ensure better outcomes without educational access. The research advocates for a health intervention strategy focusing on socioeconomic factors and public health initiatives to reduce maternal health disparities while exploring the role of partner stability and psychosocial aspect
背景:妊娠诱发高血压疾病(PIHD)包括子痫前期、子痫和妊娠高血压等病症,影响全球 5-10% 的孕妇。在撒哈拉以南非洲地区,16%的孕产妇死亡是由这些疾病造成的,在埃塞俄比亚,16.9%的孕产妇死亡是由这些疾病造成的,占该国孕产妇死亡总数的 10%:目的:确定埃塞俄比亚锡达玛公立医院和初级卫生保健单位(卫生中心)的孕妇和分娩妇女患 PIHD 的预测因素:方法:对随机抽取的 12 家公立医疗机构(包括 1 家专科教学医院、2 家综合医院、3 家初级医院和 6 家保健中心)的产前护理和妇产科妇女进行了一项多中心非匹配病例对照研究。研究在 2023 年 12 月至 2024 年 2 月期间选取了 920 名妇女(230 名病例和 690 名对照)。病例包括妊娠 20+ 周、患有子痫前期、子痫、妊娠高血压、慢性高血压合并子痫前期等 PIHD 的孕妇或产妇。对照组为血压正常的孕妇或妊娠 20 周后无 PIHD 的产妇。数据使用 Epidata 软件进行人工核实、输入和验证,然后使用 SPSS 22 进行分析。单变量分析评估了 PIHD 的预测因素,二元逻辑回归评估了各因素之间的关系。使用共线性评估和 Hosmer-Lemeshow 检验检查模型是否合适,变量的 P 值为 结果:在 920 名计划参与者中,有 686 人被纳入,响应率为 94.35%。与妇女 PIHD 相关的因素包括首次受孕年龄(AOR = 1.26)、中(AOR = 6.05)和高(AOR = 5.01)财富指数水平、多胎妊娠(AOR = 4.34)、妊娠年龄≥ 42 周(AOR = 3.65)、产妇中上臂围(MUAC)(AOR = 1.29)、血红蛋白水平为 6.5-10.9 g/dL (AOR = 5.59)、孕前体重指数 (BMI) ≥ 25 kg/M2 (AOR = 0.81)、原有高血压 (AOR = 8.97)、糖尿病家族史 (AOR = 20.02)、曾饮酒 (AOR = 0.27) 和孕期总体力活动量 (AOR = 0.54):本研究确定了女性 PIHD 的主要预测因素,包括受孕年龄、财富指数、多胎妊娠、孕龄和孕前体重指数。研究强调了社会经济地位与孕产妇健康之间的联系,并着重指出,如果没有接受教育的机会,仅靠财政资源并不能确保更好的结果。该研究提倡采取健康干预战略,重点关注社会经济因素和公共卫生举措,以减少孕产妇健康差异,同时探讨伴侣稳定性和社会心理方面的作用。
{"title":"Pregnancy-Induced Hypertensive Disorders predictors among pregnant and delivery mothers receiving care in public health institutions in Sidama, Ethiopia: a multicenter case control study.","authors":"Girma Tenkolu Bune","doi":"10.1186/s12884-024-06886-1","DOIUrl":"10.1186/s12884-024-06886-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pregnancy-Induced Hypertensive Disorders (PIHD) include conditions like Pre-Eclampsia, Eclampsia, and Gestational Hypertension, impacting 5-10% of pregnancies globally. These disorders are responsible for 16% of maternal deaths in Sub-Saharan Africa and account for 16.9% of maternal mortality in Ethiopia, representing 10% of the country's total maternal deaths.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To identify predictors of PIHD among pregnant and delivery women in public hospitals and primary health care units (health centers) in Sidama, Ethiopia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A multi-center unmatched case-control study was conducted on women in antenatal care and obstetrics/gynecology departments at 12 randomly selected public health institutions, including one specialized teaching hospital, two general hospitals, three primary hospitals, and six health centers. The study involved 920 women (230 cases and 690 controls) selected from December 2023 to February 2024. Cases included pregnant or delivery women at 20 + weeks gestation with PIHD such as pre-eclampsia, eclampsia, gestational hypertension, and chronic hypertension with superimposed preeclampsia. Controls were normotensive pregnant women or delivering mothers without PIHD after 20 weeks gestation. Data was manually verified, entered, and validated using Epidata software, followed by analysis with SPSS 22. Univariate analysis assessed predictors of PIHD, while binary logistic regression evaluated the relationships between factors. Model fitness was checked using collinearity assessments and the Hosmer-Lemeshow test, with variables having a P value &lt; 0.05 deemed independent predictors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 920 planned participants, 686 were included, resulting in a response rate of 94.35%. Factors associated with PIHD in women included age at first conception (AOR = 1.26), mid (AOR = 6.05) and high (AOR = 5.01) wealth index levels, multigravidity (AOR = 4.34), pregnancy age ≥ 42 weeks (AOR = 3.65), maternal mid-upper arm circumference (MUAC) (AOR = 1.29), hemoglobin levels of 6.5-10.9 g/dL (AOR = 5.59), pre-pregnancy Body Mass Index (BMI) ≥ 25 kg/M&lt;sup&gt;2&lt;/sup&gt; (AOR = 0.81), preexisting hypertension (AOR = 8.97), family history of diabetes mellitus (AOR = 20.02), former alcohol consumption (AOR = 0.27), and total physical activity during pregnancy (AOR = 0.54).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The study identifies key predictors of PIHD in women, including age at conception, wealth index, multigravidity, gestational age, and pre-pregnancy BMI. It underscores the link between socioeconomic status and maternal health, highlighting that financial resources alone don't ensure better outcomes without educational access. The research advocates for a health intervention strategy focusing on socioeconomic factors and public health initiatives to reduce maternal health disparities while exploring the role of partner stability and psychosocial aspect","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Maternal adiposity measures and hypertensive disorders of pregnancy: a meta-analysis. 孕产妇脂肪测量与妊娠高血压疾病:一项荟萃分析。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-16 DOI: 10.1186/s12884-024-06788-2
Caiping Xiang, Lun Sui, Xueteng Ding, Min Cao, Guoju Li, Zhanhui Du

Background: Hypertensive disorders of pregnancy (HDP) are a prevalent complication during pregnancy with significant implications for maternal and perinatal health globally. Maternal obesity is a known risk factor for HDP. This review sought to identify adiposity indicators in early pregnancy that are linked to the development of HDP.

Methods: We conducted a systematic search of the PubMed, Science Citation Index (Web of Science), and Embase databases. Screening and quality evaluation of studies was conducted independently by two reviewers. Both random effects meta-analysis and narrative synthesis were performed.

Results: Thirty-one studies were included with a pooled sample of 81,311 women. The meta-analysis showed that the odds of HDP were significantly increased by higher pregnancy measures of adiposity (pre-pregnancy body mass index (OR = 2.14, 95%CI: 1.67-2.75), visceral adipose tissue (OR = 1.79, 95%CI: 1.01-3.16), subcutaneous adiposity thickness (OR = 1.67, 95%CI: 1.36-2.05), waist circumference (OR = 2.20, 95%CI: 1.37-3.54), waist to-hip ratio (OR = 3.08, 95% CI: 1.38-6.87), weight gain (OR = 1.69, 95%CI: 1.42-2.02) and percentage body fat (OR = 1.71, 95%CI: 1.16-2.53)). Epicardial fat thickness was significantly associated with HDP, although limited data were available.

Conclusions: The results of our study highlight the importance of investigating the predictive value of adiposity measures in identifying the risk of HDP to tailor care towards women at the highest risk.

背景:妊娠期高血压疾病(HDP)是妊娠期的一种常见并发症,对全球孕产妇和围产期健康具有重大影响。孕产妇肥胖是妊娠高血压疾病的一个已知风险因素。本综述旨在确定与妊娠期高血压发病有关的孕早期肥胖指标:我们对 PubMed、科学引文索引(Web of Science)和 Embase 数据库进行了系统检索。研究的筛选和质量评估由两名审稿人独立完成。同时进行了随机效应荟萃分析和叙述性综合分析:共纳入 31 项研究,汇总样本为 81 311 名女性。荟萃分析表明,妊娠期脂肪含量越高(妊娠前体重指数(OR = 2.14,95%CI:1.67-2.75)、内脏脂肪组织(OR = 1.79,95%CI:1.01-3.16)、皮下脂肪含量(OR = 2.14,95%CI:1.67-2.75)),发生 HDP 的几率就会显著增加。16)、皮下脂肪厚度(OR = 1.67,95%CI:1.36-2.05)、腰围(OR = 2.20,95%CI:1.37-3.54)、腰臀比(OR = 3.08,95%CI:1.38-6.87)、体重增加(OR = 1.69,95%CI:1.42-2.02)和体脂百分比(OR = 1.71,95%CI:1.16-2.53))。心外膜脂肪厚度与 HDP 显著相关,但可用数据有限:我们的研究结果凸显了研究脂肪测量在识别 HDP 风险方面的预测价值的重要性,以便为高风险妇女提供量身定制的护理。
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引用次数: 0
Risk factors of severe postpartum hemorrhage in pregnant women with placenta previa or low-lying placenta: a retrospective cohort study. 前置胎盘或低置胎盘孕妇产后严重出血的风险因素:一项回顾性队列研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-15 DOI: 10.1186/s12884-024-06876-3
Huiying Hu, Liying Wang, Jinsong Gao, Ziyi Chen, Xiaoxu Chen, Pingping Tang, Yifeng Zhong

Background: The severe postpartum hemorrhage (SPPH) leads to dangerous maternal conditions, and its rate is still increasing and the trend in related risk factors is changing. Placenta-related problems remain the high-risk factor for SPPH. The object is to investigate the prevalence and the risk factors of the severe postpartum hemorrhage in pregnant women with placenta previa or low-lying placenta.

Method: A retrospective analysis of pregnant women with placenta previa or low-lying placenta after 28 weeks gestation from May 2018 to May 2023 in the Peking Union Medical College Hospital was conducted. The primary outcome was severe postpartum hemorrhage defined as blood loss ≥ 1000 mL within 24 h of childbirth, or with signs or symptoms of low blood volume requiring transfusion of ≥ 4U of red blood cells. Univariate and multivariate logistic regression were used to identify potential risk factors of severe postpartum hemorrhage and receiver operating curve to evaluate the prediction performance.

Results: Of the 14,964 women, 201 met the inclusive criteria. SPPH rate was 1.3% overall and 18.9% in women with placenta previa or low-lying placenta. Weight (aOR = 0.93, 95%CI 0.87-0.99), increta or percreta placenta (aOR = 7.93, 95%CI 2.53-24.77) were the risk factors. The area under the ROC curve was 0.69(95%CI 0.59-0.80) for increta or percreta placenta alone, and 0.72(95%CI 0.62-0.82) for the combination of times of cesarean sections and anterior placenta.

Conclusions: Placenta accreta spectrum was the key independent risk factor of SPPH in women with placenta previa or low-lying placenta. Antenatal risk assessment of SPPH in these population is highly desirable and optimal intervention could be planned.

背景:严重产后出血(SPPH)会导致产妇出现危险状况,其发生率仍在上升,相关风险因素的趋势也在发生变化。胎盘相关问题仍是 SPPH 的高危因素。本研究旨在探讨前置胎盘或低置胎盘孕妇产后严重出血的发生率及其风险因素:方法:对北京协和医院2018年5月至2023年5月妊娠28周后发生前置胎盘或低置胎盘的孕妇进行回顾性分析。主要结局为严重产后出血,定义为产后24 h内失血量≥1000 mL,或出现低血容量症状或体征,需要输注≥4U红细胞。采用单变量和多变量逻辑回归确定产后大出血的潜在风险因素,并用接收器操作曲线评估预测效果:结果:在 14964 名产妇中,201 名符合包容性标准。严重产后出血率为1.3%,前置胎盘或低置胎盘产妇的严重产后出血率为18.9%。体重(aOR = 0.93,95%CI 0.87-0.99)、前置胎盘或低置胎盘(aOR = 7.93,95%CI 2.53-24.77)是风险因素。单纯增厚胎盘或前置胎盘的ROC曲线下面积为0.69(95%CI 0.59-0.80),剖宫产次数和前置胎盘的ROC曲线下面积分别为0.72(95%CI 0.62-0.82):结论:前置胎盘或低置胎盘产妇发生 SPPH 的主要独立风险因素是胎盘早剥频谱。对这些人群进行SPPH产前风险评估是非常有必要的,并可计划最佳干预措施。
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引用次数: 0
Determinants of meconium-stained amniotic fluid among women delivered at southwestern referral hospitals, Southwest Ethiopia: a multi-center case-control study. 在埃塞俄比亚西南部转诊医院分娩的产妇羊水带胎粪的决定因素:一项多中心病例对照研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-14 DOI: 10.1186/s12884-024-06867-4
Rebuma Sorsa, Tesfaye Adugna, Kumsa Kene, Deriba Abera, Diriba Dereje, Bati Leta, Hawi Gobena, Diriba Sufa, Urge Gerema

Background: Meconium-stained amniotic fluid (MSAF) is a condition in which meconium is present in the uterus during ante-natal and complicates 10-15% of all live births. Scanty information is known about the determinants of meconium-stained amniotic fluid. Hence, this study aimed to identify determinants of meconium-stained amniotic fluid among women delivered at southwestern referral hospitals in southwest Ethiopia, in 2024.

Methods: An institutional-based case-control study was employed from January 1, 2024, to June 30, 2024. The study was conducted in four southwestern referral hospitals in southwest Ethiopia. The final sample size includes 321(107 cases and 214 controls). The sample size was proportionally allocated for cases and controls for each referral hospital. Simple random sampling was used to select patient charts and data was collected from the chart using questions/tools developed after reviewing relevant literature. Data were entered using Epi-data version 3.1 and analyzed using SPSS version 25. Data was analyzed using binary logistic regression. All independent variables with P- the value of < 0.25 in univariable analysis were considered for multivariable logistic regression. Determinant factors of meconium-stained amniotic fluid were identified at a 95% confidence interval with a p-value < 0.05 was utilized to declare statistical significance.

Results: A total of 107 cases and 214 controls were included in this study. The finding from this study stated that induction of labor [AOR = 2.37, 95% CI = 1.28-8.89], obstructed labor [AOR = 2.62, 95%CI = 1.1-6.79], duration of labor greater than 24 h [AOR = 2.8, 95% CI = 1.55-15.44], and premature rupture of the membrane [AOR = 2.98, 95%CI = 1.1-8.23] were found to be significantly associated with meconium-stained amniotic fluid.

Conclusion: Conclusively, a mother with induced or obstructed labor, labor duration greater than 24 h, and premature rupture of membrane need special attention during delivery care to reduce potential risk factors to feto-maternal outcomes related to meconium-stained amniotic fluid.

背景:胎粪染色羊水(MSAF)是一种产前子宫内存在胎粪的情况,在所有活产婴儿中占 10-15% 的并发症。有关胎粪染色羊水的决定因素的信息很少。因此,本研究旨在确定 2024 年在埃塞俄比亚西南部西南转诊医院分娩的产妇中胎粪染羊水的决定因素:方法:从 2024 年 1 月 1 日至 2024 年 6 月 30 日进行了一项基于机构的病例对照研究。研究在埃塞俄比亚西南部的四家西南转诊医院进行。最终样本量为 321 个(107 个病例和 214 个对照)。样本量按比例分配给各转诊医院的病例和对照组。采用简单随机抽样法选取患者病历,并通过查阅相关文献后开发的问题/工具从病历中收集数据。数据使用 Epi-data 3.1 版输入,并使用 SPSS 25 版进行分析。数据分析采用二元逻辑回归法。所有自变量的 P 值均为结果:本研究共纳入 107 例病例和 214 例对照。研究结果表明,引产[AOR = 2.37,95% CI = 1.28-8.89]、难产[AOR = 2.62,95%CI = 1.1-6.79]、产程超过 24 小时[AOR = 2.8,95% CI = 1.55-15.44]和胎膜早破[AOR = 2.98,95%CI = 1.1-8.23]与胎粪染羊水显著相关:最后,引产或难产、产程超过 24 小时和胎膜早破的产妇在分娩护理过程中需要特别注意,以减少与带菌羊水相关的胎儿-产妇结局的潜在风险因素。
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引用次数: 0
Spatial heterogeneity in unintended pregnancy and its determinants in India. 印度意外怀孕的空间异质性及其决定因素。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-14 DOI: 10.1186/s12884-024-06850-z
Anshika Singh, Mahashweta Chakrabarty, Aditya Singh, Shivani Singh, Rakesh Chandra, Pooja Tripathi
<p><strong>Background: </strong>Understanding the geographic variation of unintended pregnancy is crucial for informing tailored policies and programs to improve maternal and child health outcomes. Although spatial analyses of unintended pregnancy have been conducted in several developing countries, such research is lacking in India. This study addresses this gap by investigating the geographic distribution and determinants of unintended pregnancy in India.</p><p><strong>Methods: </strong>We analysed data from the National Family Health Survey-5 encompassing 232,920 pregnancies occurring between 2014 and 2021 in India. We conducted a spatial analysis to investigate the distribution of unintended pregnancies at both state and district levels using choropleth maps. To assess spatial autocorrelation, Global Moran's I statistic was employed. Cluster and outlier analysis techniques were then utilized to identify significant clusters of unintended pregnancies across India. Furthermore, we employed Spatial Lag Model (SLM) and Spatial Error Model (SEM) to investigate the factors influencing the occurrence of unintended pregnancies within districts.</p><p><strong>Results: </strong>The national rate of unintended pregnancy in India is approximately 9.1%, but this rate varies significantly between different states and districts of India. The rate exceeded 10% in the states situated in the northern plain such as Haryana, Delhi, Uttar Pradesh, Bihar, and West Bengal, as well as in the Himalayan states of Himachal Pradesh, Uttarakhand, Sikkim, and Arunachal Pradesh. Moreover, within these states, numerous districts reported rates exceeding 15%. The results of Global Moran's I indicated a statistically significant geographical clustering of unintended pregnancy rates at the district level, with a coefficient of 0.47 (p < 0.01). Cluster and outlier analysis further identified three major high-high clusters, predominantly located in the districts of Arunachal Pradesh, northern West Bengal, Bihar, western Uttar Pradesh, Haryana, Delhi, alongside a few smaller clusters in Odisha, Madhya Pradesh, Uttarakhand, and Himachal Pradesh. This geographic clustering of unintended pregnancy may be attributed to factors such as unmet needs for family planning, preferences for smaller family sizes, or the desire for male children. Results from the SEM underscored that parity and use of modern contraceptive were statistically significant predictors of unintended pregnancy at the district level.</p><p><strong>Conclusion: </strong>Our analysis of comprehensive, nationally representative data from NFHS-5 in India reveals significant geographical disparities in unintended pregnancies, evident at both state and district levels. These findings underscore the critical importance of targeted policy interventions, particularly in geographical hotspots, to effectively reduce unintended pregnancy rates and can contribute significantly to improving reproductive health outcomes across the co
背景:了解意外怀孕的地域差异对于制定有针对性的政策和计划以改善母婴健康状况至关重要。虽然一些发展中国家已对意外怀孕进行了空间分析,但印度却缺乏此类研究。本研究通过调查印度意外怀孕的地理分布和决定因素,填补了这一空白:我们分析了第五次全国家庭健康调查(National Family Health Survey-5)中的数据,这些数据涵盖了 2014 年至 2021 年期间在印度发生的 232 920 例妊娠。我们进行了空间分析,利用choropleth 地图调查了意外怀孕在邦和地区层面的分布情况。为了评估空间自相关性,我们使用了全球莫兰 I 统计量。然后利用聚类和离群值分析技术来确定印度各地意外怀孕的重要聚类。此外,我们还采用了空间滞后模型(SLM)和空间误差模型(SEM)来研究影响各地区意外怀孕发生率的因素:印度全国的意外怀孕率约为 9.1%,但这一比率在印度不同邦和地区之间存在显著差异。位于北部平原的哈里亚纳邦、德里邦、北方邦、比哈尔邦和西孟加拉邦以及喜马拉雅山脉的喜马偕尔邦、北阿坎德邦、锡金邦和阿鲁纳恰尔邦的意外怀孕率超过了 10%。此外,在这些邦中,许多地区报告的比率超过了 15%。全球莫兰 I 指数的结果表明,在地区一级,意外怀孕率在统计学上具有显著的地理聚集性,系数为 0.47(p 结论):我们对印度第五次全国人口与健康调查(NFHS-5)中具有全国代表性的综合数据进行的分析表明,意外怀孕的地域差异在邦和地区层面都很明显。这些研究结果突出表明,有针对性的政策干预措施,尤其是在地理热点地区的干预措施,对于有效降低意外怀孕率至关重要,并能极大地促进改善全国的生殖健康成果。
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引用次数: 0
Understanding the body image perception of pregnant women during their third trimester in a tertiary care setting in Southern India. 了解印度南部一家三级医疗机构中怀孕三个月的孕妇对身体形象的看法。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-14 DOI: 10.1186/s12884-024-06864-7
Ketaki Desai, Deepalaxmi Paresh Poojari, T S Shwetha, Rajani Upadhyaya, Preetha Ramachandra

Background: Pregnancy is a known physiological phenomenon characterized by various changes in the body. The physical and physiological changes that occur during pregnancy may impact the body image which may lead to implications such as body image issues or poor eating habits among pregnant women. This study aimed to analyze the body image perception of pregnant women in their third trimester.

Methods: This cross-sectional survey which involved the administration of a Multidimensional Body Self-Relations Questionnaire (MBSRQ), was conducted among pregnant women between 28 and 40 weeks of gestation in a tertiary care setting in Southern India. Descriptive statistics were used to report the demographic characteristics of the respondents. A one-sample t-test was used to analyze the difference between the present sample scores and the published norms of MBSRQ. Univariate Logistic Regression was done to find the association between the demographic variables and subdomains of MBSRQ.

Results: The mean age of the respondents (n = 246) was 29.5 years, and the period of gestation was 33.4 weeks. With mean scores of subscales of MSRQ as reference values, a greater proportion of women had higher scores on appearance orientation (52.44%), health evaluation (56.91%), and illness orientation (55.28%). Respondents scored less on appearance evaluation (52.03%) and body areas satisfaction scale (50.41%). The study found that pre-pregnancy BMI, abdominal circumference, and weight gain during pregnancy were associated with appearance orientation, overweight preoccupation, and self-classified weight. Health evaluation was associated with weight gain and Instagram use, while moderate-intensity physical activity during pregnancy was associated with higher health orientation.

Conclusion: Although pregnant women in our setting during the third trimester were oriented towards their appearance and considered themselves healthy and fit, almost half of the respondents reported dissatisfaction with their changing bodies and appearance. Self-reported physical activity status, body mass index, weight gain, level of education, use of Instagram app, and type of family were factors found to affect pregnant body image perception. Hence, we conclude that body image perception is affected during pregnancy, and healthcare professionals should be aware of this, and the factors associated with it while addressing the health of pregnant women.

Clinical trial registration details: The study was registered under the Clinical Trials Registry- India: CTRI/2023/08/056524. https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=89771&EncHid=39880.12369&modid=1&compid=19 .

背景:怀孕是一种众所周知的生理现象,其特点是身体发生各种变化。怀孕期间发生的身体和生理变化可能会影响孕妇的身体形象,从而导致身体形象问题或不良饮食习惯等影响。本研究旨在分析怀孕三个月孕妇的身体形象认知:这项横断面调查使用了多维身体自我关系问卷(MBSRQ),调查对象是印度南部一家三级医疗机构中妊娠 28 至 40 周的孕妇。描述性统计用于报告受访者的人口统计学特征。采用单样本 t 检验分析本样本得分与已公布的 MBSRQ 标准之间的差异。为找出人口统计学变量与 MBSRQ 子域之间的关联,进行了单变量逻辑回归:受访者(n = 246)的平均年龄为 29.5 岁,孕期为 33.4 周。以 MSRQ 各分量表的平均分作为参考值,外观取向(52.44%)、健康评价(56.91%)和疾病取向(55.28%)得分较高的女性比例较大。受访者在外貌评价(52.03%)和身体部位满意度量表(50.41%)上的得分较低。研究发现,孕前体重指数、腹围和孕期体重增加与外貌取向、超重预感和自我体重分类有关。健康评价与体重增加和使用 Instagram 有关,而孕期中等强度的体育活动与较高的健康取向有关:尽管在我们的环境中,怀孕三个月的孕妇注重自己的外表,并认为自己是健康和合适的,但几乎有一半的受访者表示对自己不断变化的身体和外表不满意。我们发现,自我报告的体育锻炼状况、体重指数、体重增加、教育水平、Instagram 应用程序的使用以及家庭类型都是影响孕妇身体形象认知的因素。因此,我们得出结论,身体形象认知在怀孕期间会受到影响,医护人员在关注孕妇健康时应了解这一点以及与之相关的因素:本研究已在印度临床试验注册中心注册:CTRI/2023/08/056524. https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=89771&EncHid=39880.12369&modid=1&compid=19 .
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引用次数: 0
Routine uptake of prenatal iron-folic acid supplementation and associated factors among pregnant women in peri-urban areas of Dodoma City, Tanzania: a cross-sectional study. 坦桑尼亚多多马市郊区孕妇对产前铁-叶酸补充剂的常规摄入情况及相关因素:一项横断面研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-14 DOI: 10.1186/s12884-024-06871-8
Mariam J Munyogwa, Nyasiro S Gibore, Agatha F Ngowi, Ipyana H Mwampagatwa

Background: The physiological requirements for iron and folic acid in pregnancy are a significant challenge to achieve through normal dietary intake, especially in low resource settings. The World Health Organization recommends daily oral iron and folic acid supplementation (IFAS) to prevent maternal anaemia and related adverse effects in community settings where the prevalence of anaemia during pregnancy is > 40%. The objective of this study was to assess the routine uptake of prenatal iron-folic acid supplementation and associated factors among pregnant women at peri-urban areas of Dodoma City, Tanzania.

Methods: A cross-sectional study was conducted in peri-urban areas. Data was collected through face-to-face interviews and review of records from maternal clinic card (RCH 4 card). Routine uptake of iron-folic acid supplementation was defined as pregnant woman who reported taking iron-folic acid supplements at least once within the past seven days prior to data collection. Frequency and percentage were used to report respondents' characteristics and uptake of prenatal iron-folic acid supplementation. Chi-square test and logistic regression were conducted to determine the relationship and association of routine uptake of iron-folic acid supplementation with respondents' characteristics.

Results: The total respondents were 452. Overall routine uptake of iron-folic acid supplementation was 35.6% (161). The majority of the respondents (66.5%) initiated iron-folic acid supplementation during the second trimester of pregnancy. Most of the respondents (86.3%) obtained IFA supplements at the health centers where they were receiving antenatal care. The prevalence of routine uptake of iron-folic acid supplementation was significantly higher among women in the third trimester of pregnancy (54.9%), those with more than a five-year interval since last pregnancy (40.6%), those with at least four antenatal care (ANC) visits (73.7%) and women who had undergone haemoglobin testing in the current pregnancy (63.0%). Factors associated with routine uptake of iron-folic acid supplementation were; frequency of ANC visits (AOR = 1.69) and haemoglobin testing (AOR = 3.02).

Conclusion: Approximately one third of the pregnant women took iron-folic acid supplementation at least once a week. The current frequency for intake of iron-folic acid supplementation can be described as intermittent. This practise is unacceptable for prevention of maternal anaemia and associated adverse pregnant outcomes. Frequency of ANC visits and haemoglobin testing during pregnancy were found to be associated with routine uptake of iron-folic acid supplements. Stakeholders are urged to consider novel systems for provision of prenatal IFAS in community settings with limited access to health-care professionals to ensure a timely and continuous supply of supplements.

背景:妊娠期对铁和叶酸的生理需求是通过正常膳食摄入来实现的一项重大挑战,尤其是在资源匮乏的环境中。世界卫生组织建议,在孕期贫血发生率大于 40% 的社区环境中,每天口服铁和叶酸补充剂(IFAS)以预防孕产妇贫血及相关不良影响。本研究旨在评估坦桑尼亚多多马市近郊区孕妇对产前铁叶酸补充剂的常规摄入情况及相关因素:在城市周边地区进行了一项横断面研究。通过面对面访谈和查阅孕产妇门诊卡(RCH 4 卡)记录收集数据。常规服用叶酸铁补充剂的定义是,在数据收集前的过去七天内报告至少服用过一次叶酸铁补充剂的孕妇。频率和百分比用于报告受访者的特征和产前补充叶酸铁的情况。采用卡方检验(Chi-square test)和逻辑回归(Logistic regression)确定常规叶酸补充剂摄入量与受访者特征之间的关系和关联:受访者总数为 452 人。叶酸补充剂的常规摄入量为 35.6%(161 人)。大多数受访者(66.5%)在怀孕后三个月开始补充叶酸。大多数受访者(86.3%)都是在接受产前保健的医疗中心获得 IFA 补充剂的。在怀孕三个月的妇女(54.9%)、距上次怀孕间隔超过五年的妇女(40.6%)、至少接受过四次产前检查的妇女(73.7%)和在本次妊娠中接受过血红蛋白检测的妇女(63.0%)中,常规补充铁-叶酸的比例明显更高。与常规服用叶酸铁补充剂相关的因素有:产前护理就诊频率(AOR = 1.69)和血红蛋白检测(AOR = 3.02):约三分之一的孕妇每周至少补充一次叶酸。结论:大约三分之一的孕妇每周至少补充一次叶酸。这种做法对于预防孕产妇贫血和相关不良妊娠结局是不可接受的。研究发现,孕期产前检查和血红蛋白检测的频率与叶酸铁补充剂的常规摄入量有关。敦促利益相关者考虑在医疗保健专业人员有限的社区环境中提供产前 IFAS 的新型系统,以确保及时、持续地供应补充剂。
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引用次数: 0
Socioecological factors influencing the risk of developing hypertensive disorders of pregnancy in India: a rapid review. 影响印度妊娠期高血压疾病发病风险的社会生态因素:快速综述。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-12 DOI: 10.1186/s12884-024-06879-0
Anumita Alur, Jennifer E Phipps, Leigh Ann Simmons

Background: The prevalence of hypertensive disorders of pregnancy (HDPs) in India is 11%, which is one of the highest rates globally. Existing research on HDPs in India primarily focuses on biological risk factors, with minimal research on how socioecological factors combine to increase risk of HDPs. We conducted a rapid review using Bronfenbrenner's Ecological Model to understand the social and cultural factors associated with HDPs among Indian pregnant women to identify possible intervention targets that may uniquely improve health in this population. Bronfenbrenner's Ecological Model is a framework that can be used to understand the complex relationship between multiple influences on health.

Methods: We reviewed studies published between January 2010 and January 2024 using PubMed, Science Direct, and Scopus databases. Search terms included variants of hypertension, pregnancy, and India. Inclusion criteria were: (1) peer-reviewed journal article; (2) published between January 2010 to January 2024; (3) participants consisted of Indian women living in India; (4) studies evaluated socioecological risk factors associated with HDPs. One independent reviewer performed searches, screening, data extraction, and quality assessment. Each included study was then organized within Bronfenbrenner's Ecological Model.

Results: A total of 921 studies were generated from the initial search, with 157 exclusions due to duplicates. Following screening for inclusion and exclusion criteria at the title/abstract and full text levels, 17 studies remained in the final review. Socioecological risk factors of HDPs were identified at each level, with the most commonly identified influences including: low socioeconomic status (SES), lacking community education and knowledge on HDP management and prevention, and lacking prenatal HDP screening.

Conclusion: This study determined that the high risk for HDPs in India is influenced by many intertwined socioecological factors. Women in rural and low SES areas need more health education on HDP management and prevention. There also needs to be more adequate prenatal HDP screening, with at least 4 and ideally 8 prenatal visits. Prenatal screenings should be accompanied with culturally appropriate patient education, especially for low SES women who have limited literacy, so that they can effectively make individual and microsystemic lifestyle decisions aimed at either managing or preventing HDPs.

背景:印度妊娠期高血压疾病(HDPs)的发病率为 11%,是全球发病率最高的国家之一。关于印度妊娠高血压疾病的现有研究主要集中在生物风险因素上,而关于社会生态因素如何共同增加妊娠高血压疾病风险的研究却少之又少。我们利用布朗芬布伦纳的生态模型进行了快速回顾,以了解与印度孕妇 HDPs 相关的社会和文化因素,从而确定可能的干预目标,独特地改善这一人群的健康状况。布朗芬布伦纳的生态模型是一个可用于理解对健康的多种影响因素之间复杂关系的框架:我们使用 PubMed、Science Direct 和 Scopus 数据库对 2010 年 1 月至 2024 年 1 月间发表的研究进行了回顾。检索词包括高血压、妊娠和印度的变体。纳入标准为(1) 同行评审期刊文章;(2) 2010 年 1 月至 2024 年 1 月间发表;(3) 参与者包括居住在印度的印度妇女;(4) 研究评估了与 HDPs 相关的社会生态风险因素。一位独立审稿人负责检索、筛选、数据提取和质量评估。然后根据布朗芬布伦纳的生态模型对每项纳入的研究进行整理:初步搜索共产生了 921 项研究,其中 157 项因重复而被排除。在对标题/摘要和全文进行纳入和排除标准筛选后,最终审查中保留了 17 项研究。在每个层面上都确定了 HDPs 的社会生态风险因素,其中最常见的影响因素包括:社会经济地位低(SES)、缺乏有关 HDP 管理和预防的社区教育和知识,以及缺乏产前 HDP 筛查:这项研究表明,印度 HDPs 的高风险受到许多相互交织的社会生态因素的影响。农村和社会经济地位较低地区的妇女需要更多有关 HDP 管理和预防的健康教育。还需要进行更充分的产前 HDP 筛查,至少进行 4 次产前检查,最好是 8 次。在进行产前筛查的同时,还应开展与文化相适应的患者教育,尤其是针对文化水平有限的低社会经济地位妇女,以便她们能够有效地做出个人和微观系统的生活方式决定,从而控制或预防 HDP。
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引用次数: 0
Partnership quality and maternal depressive symptoms in the transition to parenthood: a prospective cohort study. 为人父母过渡期的伴侣关系质量与产妇抑郁症状:一项前瞻性队列研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-12 DOI: 10.1186/s12884-024-06757-9
Cornelia E Schwarze, Veronika Lerche, Stephanie Wallwiener, Sabina Pauen

Background: Pregnancy and childbirth are critical life events which lead to significant changes in family structures and roles, thus having a substantial impact on partner relationship and maternal wellbeing. A dysfunctional partnership during this critical time of life has been associated with maternal depressiveness. However, sub-components of partnership quality and the causal relation with maternal symptoms of depression in the perinatal period have been sparsely studied so far. The current study aims to longitudinally assess the course of relationship quality and its sub-components from pregnancy to postpartum and to test a potential causal association with maternal symptoms of depression in the perinatal period.

Methods: Differing from previous studies, partnership quality and symptoms of depression have been assessed prospectively and longitudinally from an early stage of pregnancy (second trimester) until six months postpartum. Cross-lagged panel models were applied to investigate a potential causal relationship between partnership quality and maternal depressive symptoms.

Results: Relationship quality decreased significantly during the transition to parenthood (p < .05) with the steepest decline referring to tenderness (p < .001). We also found a substantial association of relationship quality and maternal depressiveness, but no indication for a clear causal direction of this association.

Conclusions: Our results suggest that relationship quality and maternal depressiveness are substantially related in the perinatal period, thus pointing to the need of early prevention and intervention programs for peripartum women and their partners to prevent adverse outcome for the couple and the family.

背景:怀孕和分娩是人生的重要事件,会导致家庭结构和角色发生重大变化,从而对伴侣关系和孕产妇福祉产生重大影响。在人生的这一关键时期,伴侣关系失调与产妇抑郁有关。然而,迄今为止,关于伴侣关系质量的子要素以及与围产期产妇抑郁症状的因果关系的研究还很少。本研究旨在纵向评估从孕期到产后的伴侣关系质量及其子成分的变化过程,并检验其与围产期产妇抑郁症状的潜在因果关系:与以往研究不同的是,该研究从怀孕早期(第二个三月)至产后六个月对伴侣关系质量和抑郁症状进行了前瞻性纵向评估。研究采用了跨滞后面板模型来研究伴侣关系质量与产妇抑郁症状之间的潜在因果关系:结果:在为人父母的过渡期,伴侣关系质量明显下降(p 结论:在为人父母的过渡期,伴侣关系质量与产妇抑郁症状之间存在因果关系:我们的研究结果表明,在围产期,伴侣关系质量与产妇抑郁症状密切相关,因此有必要为围产期妇女及其伴侣提供早期预防和干预计划,以防止对夫妇和家庭造成不良后果。
{"title":"Partnership quality and maternal depressive symptoms in the transition to parenthood: a prospective cohort study.","authors":"Cornelia E Schwarze, Veronika Lerche, Stephanie Wallwiener, Sabina Pauen","doi":"10.1186/s12884-024-06757-9","DOIUrl":"https://doi.org/10.1186/s12884-024-06757-9","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy and childbirth are critical life events which lead to significant changes in family structures and roles, thus having a substantial impact on partner relationship and maternal wellbeing. A dysfunctional partnership during this critical time of life has been associated with maternal depressiveness. However, sub-components of partnership quality and the causal relation with maternal symptoms of depression in the perinatal period have been sparsely studied so far. The current study aims to longitudinally assess the course of relationship quality and its sub-components from pregnancy to postpartum and to test a potential causal association with maternal symptoms of depression in the perinatal period.</p><p><strong>Methods: </strong>Differing from previous studies, partnership quality and symptoms of depression have been assessed prospectively and longitudinally from an early stage of pregnancy (second trimester) until six months postpartum. Cross-lagged panel models were applied to investigate a potential causal relationship between partnership quality and maternal depressive symptoms.</p><p><strong>Results: </strong>Relationship quality decreased significantly during the transition to parenthood (p < .05) with the steepest decline referring to tenderness (p < .001). We also found a substantial association of relationship quality and maternal depressiveness, but no indication for a clear causal direction of this association.</p><p><strong>Conclusions: </strong>Our results suggest that relationship quality and maternal depressiveness are substantially related in the perinatal period, thus pointing to the need of early prevention and intervention programs for peripartum women and their partners to prevent adverse outcome for the couple and the family.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11470716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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BMC Pregnancy and Childbirth
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